Reduce Your Chances of Getting a Cumulative Trauma Disorder
by Keeping Your Muscles in Harmony
by James R. Seils,
CSP, CIE
Carpal tunnel syndrome, epicondylitis,
tenosynovitis, de Quervain’s disease, rotator cuff tendinitis, and thoracic outlet
syndrome are some of the more menacing occupationally induced cumulative trauma disorders
(CTD’s) afflicting workers today.
These diseases don't discriminate between office and
industrial workers, as anyone can be susceptible to these insidious and painful disorders.
Understanding what causes the problems and what you can do to keep yourself in a healthy
physical state to preclude unforetold injuries from occurring, however, is something every
worker should concern themselves with.
No matter what you do for a living, you use muscles
to perform. It doesn’t matter whether you are typing at a computer, repetitively
performing activities on an assembly line, lifting heavy loads in a foundry, or playing
your favorite sport or musical instrument.
When you continuously and repetitively
perform an activity over time, the muscle or muscle group you are using becomes stronger.
The body as designed, however, is made up of many balanced muscle groups which need to
maintain that balance in order to continue functioning harmoniously without any pain.
If you were to watch a professional
bodybuilder carefully, his or her objective is to develop each muscle group as evenly as
possible. You and I on the other hand often do not think about the necessity for doing
this... but we should. When you exercise the same muscles continuously while ignoring the
other muscle groups in your body, any pain you start to feel is the direct negative
consequence you pay for this inaction. Having a balanced muscle system assists your body
in maintaining proper blood flow, which is a critical function for promoting healing by
flushing away waste products that build up in your system and can cause inflammation.
Consequently, it is extremely important to
maintain a proper muscle harmony by strengthening opposing muscle groups from those we
regularly use in order to reduce the probability of a CTD occurring.
Carpal Tunnel Syndrome
Carpal tunnel syndrome results from repeated
compression of the median nerve over time. Flexor muscles of the wrist, fingers and
forearm (muscles on the palmer side of your fingers and anterior side of your wrist and
forearm) contribute to this condition when they are repeatedly contracted
and eventually become exhausted.
Examples of flexor muscle contraction would
be holding a screw between your index fingertip and your thumb, flexing a finger while
striking a key on a computer keyboard, or grasping a bowling ball with your fingers inside
the finger holes.
Once these muscles are tired, any additional
contractions at this point will require a lot more effort to accomplish the same amount of
work as before. If these muscles are not allowed to rest adequately, they can begin to
maintain a state of semi-contraction, and your fingers can lose their normal range of
mobility. When this happens, the palmer side of the carpal tunnel will have a
significantly greater than normal pressure on the outside.
These same motions also cause a problem for
your tendons that will swell and become inflamed from overuse. When that happens, your
body tries to naturally heal these inflamed tendons by providing additional synovial fluid
around them to keep them well lubricated. In doing this however, the additional rush of
fluid increases the pressure on the inside of the carpal tunnel. As a result, you now have
pressure both inside and outside the carpal tunnel that is hindering adequate blood flow
to the area and which can result in real pain.
The carpal tunnel is extremely sensitive to
any kind of pressure whether that be internal or external, and therefore it does not take
very much additional pressure to reduce blood flow to the median nerve. Although you can
permanently damage this nerve, it like most other nerves can heal and recover from the
continuous trauma you have subjected it to. The primary way to accomplish this is by
making sure that a healthy cleansing blood supply is capable of reaching the damaged
tissue.
Carpal Tunnel Surgery
Carpal tunnel surgery should be the absolute
last measure taken to resolve this problem, but
all too often there is a rush to judgment to make it the first treatment of choice. When
you cut the transverse carpal ligament to create slightly more room in the tunnel, all
this surgery does is release the pressure that has built up in the carpal tunnel as a
result of repeated and forceful exertions with incorrect posture. Like any other surgery
though, scar tissue forms and remains.
It is quite common for people who have this
surgery to continue performing the same functions that caused the problem in the first
place and end up getting carpal tunnel again. Once more they will have to make another
choice as to whether to pursue surgery or another more holistic solution. Regardless of
the treatment chosen, a critical procedure to implement is to have the conditions and
activities causing the problem evaluated by a trained ergonomist who can establish a plan
of action to eliminate the probability of recurrence.
The Muscle Balancing Alternative
Pressure begins to build up around the carpal
tunnel from the repetitive activities that cause muscular imbalance. If you maintain your
muscles in proper balance, you will dramatically inhibit abnormal pressures from occurring
around the tunnel.
The flexor muscle group as noted earlier is
the one that is overworked and overdeveloped. Therefore what you need to work on to
provide harmony to this muscle group is stretching the foreshortened flexors and
strengthening their antagonists, the extensor muscles in the fingers, wrist and forearm.
What extensor muscles and tendons do is to
allow your fingers to open up and extend themselves, while flexor muscles and tendons
allow you to move your fingers in a downward manner or close themselves altogether into
your hand such as in a gripping type motion.
It is easy to observe the difference between the two
different muscle groups by looking at your forearm. The extensor muscles which are located
on the back of your forearm are much smaller than the flexor muscles on the front.
As anyone who has ever tried bodybuilding
knows, it is difficult to accomplish very much without use of the right equipment and
training in how to use it properly to accomplish a desired objective. The same holds true
for exercising your extensor muscles. Frequency of the exercises will depend on whether
you are starting a program pre- or post- symptoms and the severity of activities
performed.
The necessary equipment is not expensive and
there are a number of companies currently marketing devices to perform these types of
exercises, but you do need instruction in how to do them properly, and an established
schedule adhered to in order to accomplish the desired results. An ergonomics consultant
or physiotherapist schooled in setting up such a program should be contacted to start such
a program.
Results You Should Expect
What is of paramount importance when
actuating a muscle balancing program specifically related to potential carpal tunnel
problems is making sure that the extensor muscles are strengthened throughout their full
range of motion. By strengthening these muscles you will help control excessive and
abnormal flexion of the wrist (movement of the hand downward) through muscle control which
previously did not exist. The result is that your greater muscle control will inhibit the
placing of unnecessary pressure on the outside of the carpal tunnel.
For those who already have occupationally
induced carpal tunnel syndrome, proper exercise will help you develop muscle group balance
which will aid your body in healing itself naturally by removing built up abnormal
pressure increases inside the tunnel. It does this by allowing a proper blood flow to the
area that assists in eliminating built up lactic acid and other waste products that the
body has not been able to successfully eliminate that contributed to the pressure buildup
in the tunnel on the median nerve in the first place.
Epicondylitis
Epicondylitis results from inflammation of
the junction of either the muscle and tendon or tendon and bone, or both, near the elbow.
Hence this term is often generically referred to in sports terms as tennis-,
golfer’s-, bowler’s-, or pitcher’s elbow. However, it would be more
properly called typist’s-, meat-cutter’s-, carpenter’s-, musician’s-,
or small parts assembly line worker’s elbow based upon how often it occurs
occupationally.
The primary reason people develop
epicondylitis is from heavy use of their wrist and fingers, particularly with respect to
activities involving repetitive or sustained gripping, and extreme postures involving
wrist flexion (bending of the hand down at the wrist) and/or extension (bending of the
hand up at the wrist). Another key activity that normally combines with the wrist/finger
motion is pronation/supination of the forearm (turning of the wrist so as to have the palm
facing downward/upward).
To best illustrate this, imagine the motion
of a tennis player who is tightly grasping his or her racquet handle and slicing under the
ball with their backhand, rotating their forearm as they follow-through to the end of the
shot. The shock and vibration that occurs can lead to an inflammation of your tissues.
Continuing to perform this motion before the tissues have properly healed will lead to
tenderness and pain not only at the elbow, but sometimes the entire forearm.
From a technical standpoint, the problem
described above also involves a lack of muscle balance control, between the flexion of the
wrist while waiting for the ball, and the stretching of the extensor muscles in the
forearm from the vibration that occurs when the ball actually strikes the racquet.
If your muscles are not strong enough, as
your follow through motion with your forearm occurs after striking the ball and you end
the shot in wrist extension, you will wind up with torn tissue at the fulcrum point,
namely the elbow joint.
Alleviating the Problem
Stretching, exercising, and strengthening
your flexor and extensor muscles in your forearm is critical to prevent or alleviate pain
if epicondylitis is the malady of concern. As before, you need a healthy supply of blood
flowing through the area to flush away lactic acid and other waste product buildup in
order to reduce inflammation and promote healing, particularly at the point where your
muscles are most susceptible to stress damage.
Again, it is important to consult an
ergonomics consultant or physiotherapist to setup a muscle building program that targets
the correct muscles for development based upon an analysis of your work activities
performed and the biomechanics of your body motions. If you are already suffering the
effects of epicondylitis, a well designed program will stimulate additional flow of blood
to the area, reducing your rehabilitation time by allowing the body to heal itself as it
was designed to.
Regardless the Activity, Muscles Need to
Work in Harmony
The same thought process applies to
the other previously mentioned CTD’s as well. Muscle balance is a critical factor in
keeping each part of your body working free from pain. Repeated use of afflicted tissues
once they have become inflamed from overuse overpowers the body’s ability to heal and
leads to pain and tenderness. This applies whether we are talking about the hand, wrist,
elbow, shoulder, knee, leg or other similar limb.
The vast majority of people take up sports to
get in shape, rather than getting in shape to play sports. As a result, injuries and pain
often result when the body is not properly prepared to absorb the forces thrown at it.
Even our strongest muscles are too weak, and there is little in the way of muscle balance.
The same is true for industrial athletes,
which includes all of us who work for a living. You will perform better at whatever task
needs to be completed that requires the use of muscles needed repetitively if you do a
little exercise beforehand on a regular basis to keep the muscle groups most used in
harmony. Your system will thank you by allowing for a continuous and healthy flow of blood
through your tissues that will help keep you free from pain and injury. |
